title: Comparative effectiveness of pleural drainage procedures for the treatment of complicated pneumonia in childhood.
abstract: OBJECTIVE
  To determine the comparative effectiveness of common pleural drainage procedures for treatment of pneumonia complicated by parapneumonic effusion (ie, complicated pneumonia).
  
  
  METHODS
  Multicenter retrospective cohort study.
  
  
  METHODS
  Forty children's hospitals contributing data to the Pediatric Health Information System.
  
  
  METHODS
  Children with complicated pneumonia requiring pleural drainage.
  
  
  METHODS
  Initial drainage procedures were categorized as chest tube without fibrinolysis, chest tube with fibrinolysis, video-assisted thoracoscopic surgery (VATS), and thoracotomy.
  
  
  METHODS
  Length of stay (LOS), additional drainage procedures, readmission within 14 days of discharge, and hospital costs.
  
  
  RESULTS
  Initial procedures among 3500 patients included chest tube without fibrinolysis (n = 1762), chest tube with fibrinolysis (n = 623), VATS (n = 408), and thoracotomy (n = 797). Median age was 4.1 years. Overall, 716 (20.5%) patients received an additional drainage procedure (range, 6.8-44.8% across individual hospitals). The median LOS was 10 days (range, 7-14 days across individual hospitals). The median readmission rate was 3.8% (range, 0.8%-33.3%). In multivariable analysis, differences in LOS by initial procedure type were not significant. Patients undergoing initial chest tube placement with or without fibrinolysis were more likely to require additional drainage procedures. However, initial chest tube without fibrinolysis was the least costly strategy.
  
  
  CONCLUSIONS
  There is variability in the treatment and outcomes of children with complicated pneumonia. Outcomes were similar in patients undergoing initial chest tube placement with or without fibrinolysis. Those undergoing VATS received fewer additional drainage procedures but had no differences in LOS compared with other strategies.
authors.affiliation: Division of Infectious Diseases, The Children's Hospital of Philadelphia and the Departments of Pediatrics and Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA. shahs@email.chop.edu
authors.forename: Samir S
authors.initials: SS
authors.lastname: Shah
authors.forename: Matthew
authors.initials: M
authors.lastname: Hall
authors.forename: Jason G
authors.initials: JG
authors.lastname: Newland
authors.forename: Thomas V
authors.initials: TV
authors.lastname: Brogan
authors.forename: Reid W D
authors.initials: RW
authors.lastname: Farris
authors.forename: Derek J
authors.initials: DJ
authors.lastname: Williams
authors.forename: Gitte
authors.initials: G
authors.lastname: Larsen
authors.forename: Bryan R
authors.initials: BR
authors.lastname: Fine
authors.forename: James E
authors.initials: JE
authors.lastname: Levin
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Wagener
authors.forename: Patrick H
authors.initials: PH
authors.lastname: Conway
authors.forename: Angela L
authors.initials: AL
authors.lastname: Myers
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004322:Drainage / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010996:Pleural Effusion / Q000150:complications* / Q000503:physiopathology / Q000628:therapy*; D011014:Pneumonia / Q000150:complications* / Q000503:physiopathology / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome